Covid-19 sars-coV-2 2019-nCov hcoV-19

COVID-19 SARS-CoV-2 2019-nCov HCoV-19

Disease

Virus Name

7 Human Coronaviruses: 4 normal; 3 “novel”

Alpha: HCoV-229E, HCoV-NL63 Beta: HCoV-HKU1, HCoV-OC43, MERS-CoV, SARS-CoV, SARS-CoV-2

“Novel” Coronaviruses

• Novel coronaviruses predominantly in LOWER respiratory tract
• SARS, MERS, SARS-CoV-2
• Don’t forget other LRIs:
• Viral Pneumonia: Influenza (A/B), Adenovirus, Parainfluenza (Type 1-4), Respiratory syncytial virus, Human metapneumovirus, NL63
• Typical bacteria CAP: Lobar – Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, Moraxella catarrhalis; Gram neg, anaerobic if aspiration
• Bacterial bronchitis or atypical CAP: Bordetella pertussis, Mycoplasma pneumoniae, and Chlamydia pneumoniae
• SARS (2002-2003): Contained. CFR 10%. >50% mortality in >60 years.
• MERS: Not Contained. CFR 35%. Linked to direct camel exposure.
• High healthcare worker infection and other nosocomial spread
• Aerosolization during procedures (intubation, nebs, BiPAP, suctioning)

Novel CoV attachment

• ACE-2 Receptors
• Type 2 alveolar cells - highest
• Bronchial epithelia
• Tongue > buccal epithelia
• Upper Intestinal epithelia
• Myocardial cells
• Kidney proximal tubule cells
• Bladder urothelial cells
• SARS-CoV-2 binds to ACE-2 Receptor 10-20x more strongly than SARS-CoV
• Question of ADEs (Antibody Dependent Enhancement)
• Antibodies can create a backdoor enhancement for viral replication
• Implications on viral replication and vaccine development safety

SARS-Cov-2 origin

• Bat to a mammal (pangolin?) to human in Nov/Dec 2019
• Pangolins used in Chinese medicine
• Probable link to seafood/exotic animal market
• Other plausible theory:
• Wuhan Level 4 Biohazard lab experimental

animals sold for human consumption

Cormorbidities and Risk Conditions

• Age
• HTN
• Diabetes
• Coronary Heart Disease
• Hep B
• Cerebrovascular Disease
• COPD
• Cancer
• Children and pregnant women seem to do okay

Person Under Investigation (PUI)

Close contact is defined as—

a) being within approximately 6 feet (2 meters) of a COVID-19 case for a prolonged period of time; close contact can occur while caring for, living with, visiting, or sharing a healthcare waiting area or room with a COVID-19 case

– or –

b) having direct contact with infectious secretions of a COVID-19 case (e.g., being coughed on)

If such contact occurs while not wearing recommended personal protective equipment or PPE (e.g., gowns, gloves, NIOSH-certified disposable N95 respirator, eye protection), criteria for PUI consideration are met.

Treatment

• Mild/moderate symptoms (80%)
• Outpatient management of symptoms and isolation
• OTC Tylenol, cough and cold medications
• Avoid steroids (ICS or oral/IM) unless compelling need (COPD or Asthma Exac)
• Possibly avoid ACEI or Ibuprofen – data unclear!
• Need to protect family members! (Check CDC guidelines)
• At least 2 weeks isolation?
• Unclear when viral shedding no longer present.
• Unclear if we will require two negative tests and/or begin testing IgM IgG

Treatment

• Moderate with risks/severe/critical symptoms (15-20%)
• BiPAP increases risk of areolation due to positive pressure (as would CPAP), AND generally patients needing BiPAP end up needing intubation.
• Patients do worse on BiPAP compared to HFNC/NRB.
• If BiPAP is the ONLY option (no vents) or is needed due to COPD, negative pressure room, air filtration, helmet interface.

Experimental Treatment & Vaccine

• Experimental:
• Lopinavir/Ritonavir (Kaletra – protease inhibitors)
• Ribavirin
• Remdesivir
• Chloroquine/hydroxychloroquine
• High dose IV Vitamin C
• IVIG
• Serum antibodies of recovered patients
• Some Vaccine trials in Phase 1 Clinical Trials

Epidemiology

“the branch of medicine which deals with the incidence, distribution, and possible control of diseases and other factors relating to health.”

• Incidence
• Prevalence
• R0 and R
• Case Fatality Rate
• Mortality Rate
• Prevention
• Containment
• Mitigation
• Infection, Prevention and Control (IPC)